Chronic pelvic pain pt 3: Vulvodynia/Vestibulodynia
Pelvic organ prolapse (POP) is a common, benign condition in women. For many women it is first noticed as a vaginal bulge associated with pressure, difficulty with urinating, bowel movements or sexual function which may adversely affect the quality of life. Women in the United States have a 13% lifetime risk of undergoing surgery with an aging population in the United States, it is anticipated that by 2050 the number of women experiencing POP will increase by approximately 50%.
The incidence of POP surgery is 1.5–1.8 surgeries per 1,000 women years. There are approximately 300,000 POP surgeries each year in the United States
Types of prolapse
Pelvic organ prolapse is the descent of one or more aspects of the vagina and uterus: the front wall of the vagina, the back wall of the vagina, the womb, the top wall of the vagina in women who have had a hysterectomy or a true hernia of the pelvis. This allows nearby organs to herniate into the vaginal space, which is commonly referred to as cystocele, rectocele, or enterocele.
Pelvic organ prolapse only should be considered a problem if it is causing prolapse symptoms which include pressure with or without a bulge, sexual dysfunction or if it is disrupting normal lower urinary tract with recurrent infections, incomplete emptying of the bladder or bowel function.
Risk factors for developing symptomatic POP include parity, vaginal delivery, age, obesity, connective tissue disorders, menopausal status, and chronic constipation. Treatment is indicated only if prolapse is causing bothersome bulge and pressure symptoms, sexual dysfunction, lower urinary tract dysfunction, or bowel dysfunction
Some symptoms related to pelvic organ prolapse may be managed with lifestyle modifications. A pessary should be considered for a woman with symptomatic POP who wishes to become pregnant in the future. A vaginal pessary is an effective nonsurgical treatment for women with POP, and up to 92% of women can be fitted successfully with a pessary.
Surgery is only indicated for the treatment of POP in women who are bothered by their POP and have failed or declined nonsurgical treatments. There are various vaginal and abdominal surgical approaches for the treatment of POP.
Urinary incontinence is a common condition that affects women 25% of young women, up to 57% of middle-aged and postmenopausal women, and 75% of older. The estimated direct cost of urinary incontinence care in the United States is estimated at $19.5 billion.
Despite the prevalence of urinary incontinence, many women are hesitant to seek care or discuss their symptoms with a physician. Only 45% of women who reported at least weekly urine leakage sought care for their incontinence symptoms.
Types of Urinary incontinence
There are three main types of urinary incontinence in women: 1) stress urinary incontinence, 2) urgency urinary incontinence, and 3) mixed urinary incontinence. Correct diagnosis is important in the evaluation and treatment of women with urinary incontinence, as is determining the effect on the woman’s quality of life. A basic office evaluation is the first and most important step in the assessment of urinary incontinence.
Treatment options for urinary incontinence range from conservative to surgical. Behavioral and lifestyle modification include bladder retraining, weight loss, dietary and fluid management. Pelvic floor muscle exercises with or without physical exercise is beneficial. Medications are available for the treatment of urinary urgency and urge incontinence.
The treatment of stress incontinence includes pelvic floor muscle exercise or surgical procedures which include the use of anti-incontinence agents or the mid-urethral sling. The midurethral sling is FDA approved for the treatment of stress urinary incontinence.
Pelvic organ prolapse and urinary incontinence affects the quality of life in women to a significant degree. A simple office evaluation in the office with your physician will help identify these problems and will help provide the necessary care needed.
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